1
|
Passos LSA, Magalhães LMD, Soares RP, Marques AF, Alves MLR, Giunchetti RC, Nunes MDCP, Gollob KJ, Dutra WO. Activation of Human CD11b + B1 B-Cells by Trypanosoma cruzi-Derived Proteins Is Associated With Protective Immune Response in Human Chagas Disease. Front Immunol 2019; 9:3015. [PMID: 30662439 PMCID: PMC6328447 DOI: 10.3389/fimmu.2018.03015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 12/05/2018] [Indexed: 01/21/2023] Open
Abstract
B-cells mediate humoral adaptive immune response via the production of antibodies and cytokines, and by inducing T-cell activation. These functions can be attributed to distinct B-cell subpopulations. Infection with Trypanosoma cruzi, the causative agent of Chagas disease, induces a polyclonal B-cell activation and lytic antibody production, critical for controlling parasitemia. Individuals within the chronic phase of Chagas disease may remain in an asymptomatic form (indeterminate), or develop severe cardiomyopathy (cardiac form) that can lead to death. Currently, there is no effective vaccine to prevent Chagas disease, and no treatment to halt the development of the cardiomyopathy once it is installed. The pathology associated with cardiac Chagas disease is a result of an inflammatory reaction. Thus, discovering characteristics of the host's immune response that favor the maintenance of favorable heart function may unveil important immunotherapeutic targets. Given the importance of B cells in antibody production and parasite control, we investigated T. cruzi-derived antigenic fractions responsible for B-cell activation and whether frequencies and functional characteristics of B-cell subpopulations are associated with different clinical outcomes of human Chagas disease. We stimulated cells from indeterminate (I) and cardiac (C) Chagas patients, as well as non-infected individuals (NI), with T. cruzi-derived protein- (PRO), glycolipid- (GCL) and lipid (LIP)-enriched fractions and determined functional characteristics of B-cell subpopulations. Our results showed that the frequency of B-cells was similar amongst groups. PRO, but not GCL nor LIP, led to an increased frequency of B1 B-cells in I, but not C nor NI. Although stimulation with PRO induced higher TNF expression by B1 B-cells from C and I, as compared to NI, it induced expression of IL-10 in cells from I, but not C. Stimulation with PRO induced an increased frequency of the CD11b+ B1 B-cell subpopulation, which was associated with better cardiac function. Chagas patients displayed increased IgM production, and activation of gamma-delta T-cells, which have been associated with B1 B-cell function. Our data showed that PRO activates CD11b+ B1 B-cells, and that this activation is associated with a beneficial clinical status. These findings may have implications in designing new strategies focusing on B-cell activation to prevent Chagas disease cardiomyopathy.
Collapse
Affiliation(s)
- Livia Silva Araújo Passos
- Laboratory of Cell-Cell Interactions, Instituto de Ciências Biológicas, Departamento de Morfologia, Belo Horizonte, Brazil.,Pós-graduação em Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luísa Mourão Dias Magalhães
- Laboratory of Cell-Cell Interactions, Instituto de Ciências Biológicas, Departamento de Morfologia, Belo Horizonte, Brazil.,Pós-graduação em Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rodrigo Pinto Soares
- Pós-graduação em Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Laboratory of Cellular and Molecular Parasitology, Instituto René Rachou, Fundação Oswaldo Cruz, FIOCRUZ, Belo Horizonte, Brazil
| | - Alexandre F Marques
- Pós-graduação em Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marina Luiza Rodrigues Alves
- Laboratory of Cell-Cell Interactions, Instituto de Ciências Biológicas, Departamento de Morfologia, Belo Horizonte, Brazil
| | - Rodolfo Cordeiro Giunchetti
- Laboratory of Cell-Cell Interactions, Instituto de Ciências Biológicas, Departamento de Morfologia, Belo Horizonte, Brazil.,Pós-graduação em Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria do Carmo Pereira Nunes
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kenneth J Gollob
- Center for International Research, A.C.Camargo Cancer Center, São Paulo, Brazil.,Instituto Nacional de Ciência e Tecnologia Doenças Tropicais, Belo Horizonte, Brazil
| | - Walderez Ornelas Dutra
- Laboratory of Cell-Cell Interactions, Instituto de Ciências Biológicas, Departamento de Morfologia, Belo Horizonte, Brazil.,Pós-graduação em Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Instituto Nacional de Ciência e Tecnologia Doenças Tropicais, Belo Horizonte, Brazil
| |
Collapse
|
2
|
Heart transplantation for Chagas cardiomyopathy. Rev Port Cardiol 2017; 36:871.e1-871.e4. [PMID: 29162358 DOI: 10.1016/j.repc.2016.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/01/2016] [Indexed: 11/22/2022] Open
Abstract
Chagas disease is an endemic disease in Latin America that is increasingly found in non-endemic areas all over the world due to the flow of migrants from Central and South America. We present the case of a Brazilian immigrant in Portugal who underwent orthotopic heart transplantation for end-stage Chagas cardiomyopathy. Immunosuppressive therapy included prednisone, mycophenolate mofetil and tacrolimus. Twelve months after the procedure she is asymptomatic, with good graft function, and with no evidence of complications such as graft rejection, opportunistic infections, neoplasms or reactivation of Trypanosoma cruzi infection. By reporting the first case in Portugal of heart transplantation for Chagas cardiomyopathy, we aim to increase awareness of Chagas disease as an emerging global problem and of Chagas cardiomyopathy as a serious complication for which heart transplantation is a valuable therapeutic option.
Collapse
|
5
|
Bestetti RB, Cury PM, Theodoropoulos TAD, Villafanha D. Trypanosoma cruzi myocardial infection reactivation presenting as complete atrioventricular block in a Chagas' heart transplant recipient. Cardiovasc Pathol 2004; 13:323-6. [PMID: 15556779 DOI: 10.1016/j.carpath.2004.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Revised: 07/21/2004] [Accepted: 08/09/2004] [Indexed: 11/17/2022] Open
Abstract
A 56-year-old man underwent orthotopic heart transplantation because of end-stage Chagas' cardiomyopathy. One hundred and ten days following heart transplantation, an electrocardiogram tracing showed complete atrioventricular block, which was treated with temporary transvenous pacemaker insertion. An underlying endomyocardial biopsy was graded 3A. The patient was treated with pulse steroid therapy. One week later, the patient died of multiorgan failure secondary to septicemia. A careful review of the endomyocardial biopsy showed nests of parasites in the myocardial tissue accompanied by mononuclear cell infiltrate similar to that found in acute graft rejection. Thus, complete atrioventricular block may be another clinical manifestation of Trypanosoma cruzi infection reactivation in Chagas' heart transplant recipients.
Collapse
Affiliation(s)
- Reinaldo B Bestetti
- Department of Cardiology, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto City, Brazil.
| | | | | | | |
Collapse
|
6
|
Malheiros SMF, Almeida DR, Massaro AR, Castelo A, Diniz RVZ, Branco JN, Carvalho AC, Gabbai AA. Neurologic complications after heart transplantation. ARQUIVOS DE NEURO-PSIQUIATRIA 2002; 60:192-7. [PMID: 12068344 DOI: 10.1590/s0004-282x2002000200002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Neurologic complications are known as important cause of morbidity and mortality in orthotopic heart transplantation. Our aim was to identify the frequency and outcome of neurologic complications after heart transplantation in a prospective observational study. METHOD From September 93 to September 99, as part of our routine heart transplantation protocol all patients with end-stage cardiac failure were evaluated by the same neurologist before and at the time of any neurologic event (symptom or complaint) after transplantation. RESULTS Out of 120 candidates evaluated, 62 were successfully transplanted (53 male; median age 45.5 years, median follow-up 26.8 months). Fifteen patients (24%) had ischemic, 22 (35%) idiopathic, 24 (39%) Chagas' disease and 1 (2%) had congenital cardiomyopathy. Neurologic complications occurred in 19 patients (31%): tremor, severe headache, transient encephalopathy and seizures related to drug toxicity or metabolic changes in 13; peripheral neuropathy in 4; and spinal cord compression in two (metastatic prostate cancer and epidural abscess). No symptomatic postoperative stroke was observed. CONCLUSIONS Although frequent, neurologic complications were seldom related to persistent neurologic disability or death. Most of the complications resulted from immunosuppression, however, CNS infection was rare. The absence of symptomatic stroke in our series may be related to the lower frequency of ischemic cardiomyopathy.
Collapse
Affiliation(s)
- Suzana M F Malheiros
- Department of Neurology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|